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Application for Private Sewege Disposal System 1967 a Installation HEALTH DEPARTMENT Date 6ne Z /967 ain ersterNq MA 6 S• APPLICATION TO INSTAL.OR REPAIR 1, PRIVATE SEWAGE DISPOSAL SYSTEM ne°are? .IYaiieotx/ imaml%9(Sr J3 '7 Crfiaa aPhoae £?7 Sea 3 (Nest be filed is) (Mailing adores) o N •/ It Address H Of Phone `v at (Meiling address) trot [/X Awes Are _sad.•..200AZ moor gn E• oeva.ennne RE 37.95/ Mailing address) LI/pSneinfrProw Rom" (Subdivision,Street or Roes Warns or Number,50010 1I,Lot No.) n of one th- 0,6 to It®tall ❑ Repair wage Disposal System e Tank s gle Dwelling Unit C TANK SYSTEM DISPOSAL OF: ditional Quarters Multiple Dwelling Unit [ 'Ordinary Household Sewage and Wastes Total No, Estimated or Actual Bed R 33 Water Comsumpti n-"•0 0 Gdy [kIn Addition Wastes from ❑ Garbage Automatic Washing Machine Disposal Device ❑ Other f Material nk: DETAILS OF SEPTIC TANK SYSTEM Rt.gncrete ❑ Other Depth Ft. Capacity 900 Depth of 3 Ditches 3 Ft Ditcher 6 ��// Surface Drainage Water Table New 6 Ft Required /44/42°. /O Ft. Wide.�—.Ft. Dep '¢ Exact.Length Width of Ditch z M Each Ditch ✓�� Ft.Di Tank: Length face No.of age Field: Di of Filter Material Base to(lover TYl //e a Inches. Soil S ation Teats Required Test Holes Z Depth of Gallons Inches Linear Ft. Percolation Rate Per Inch t M in 2e .S •C Hole No. M' .3 Ser 2a Hole No. Min. Sec. Hole No Min. Sea Signed: gh Sketch of Premises Showing Location of Buildings.Water Supply S. SEE tem.Sewage Disposal System,and other Pertinent Details p L o T' j'L Am i} T TA cY/E D Ft b ❑ Approved rt°roC ❑ Rejected Signed THIS APPLICATION MUST BE SUBMITTED IN TRIPLICATE S-3 a - - Installation ifs HEALTH wnRT fyon rMB� MASS S. APPL[GAGON.TO INSTALL OR:REPAIR PRIVATE SEWAGE,DISPOSAL SYSTEM Dater R Z /967 (Msitb none Xi 7- 4e6.Ye p dress .. Phone Or manias addr®T or e e_fit,arr S /n/C _Aetna.2a344 -Mew w Sr, te S.in as Plww WFCrF14.7P,VW RDA° tSzbditiNOa,street or Red Nema a Number.Seethe.Lot PS RIP c,6 .a glnebll 0 Repair RE 3785/ name Disposal System: le Dwelling Unit ❑ Multiple Dwelling Unit TANK SYSTEM SPOSAL OF: Itional Zuartars [j]rOrdinaryHousehold Sewage and Wastes Total No Estimated or Actual Ciel. Bed R 2 Water C r umptic^ (�In Addition Wastes from ❑,Garbage Automatic Washing Machine DlspoaalDevice Q Other Material k: DETAILS OF SEPTIC TANK SYSTEM Erouerete rank: 4oet /0 ph width ace No.of Exact Length ;e Field: Ditehei__ ,S—�0f Each Di d Filter Material ase to Cover Tih Al A 42 hmhd: 0 Other 4 FL DeptIL--t iFt. Capacity 900 Gallons Width of Depth ot Mt. are Ft.Dmh 4 Ft.Ditcher. 36'- Inrhm Depth of Surface Drainage Linear r Boil Sggd Hon TestiRequired:el Test Holes II Sketch of Premises Showing Water Ta..lada 6 Pt Redarge Pereolahim Rate Per lnrtt Zen SEC, Hole N6 Alin. 3 20 Hole No.----Min. Hole No. Min. : ..:Signed: of Buildings.Water Supply Syatem;SewageDispml System.another Pertinent Details pier paAN gTrfjcf/ED h !talent p Approved ❑ Rejected Si THIS APPLICATION MUST BE SUBMITTED IN TRIPLICATE C Y 1:1 hit k '! 12 WN i $ I Q � b v c q I / C-00 y Q I - I < - 0{. en,to• . I ' .0 Y " 4,1- - ' - - - _.� 62' q II N { Any t - I a °ok ( 4t V / 4 / og T , ' o I�'1 1 C , I , R a 9 N n IRV i. h i Z • p x - 1 s. .I, � . . } J+F$.DQ i. f S. P3't 3C .v. e 1 I 1 a A b.it r i•- B . ! . :9 . . .. •5°. I I 0 �i . . . y ;.1 � .o o q• �Vy 34 • _ _ _ _ _-r r � S k 4i t • . %3 -7. ‘-A r . I y 4...h p 1 I �• CI �. 1-7-S. SS ' •C t6 .ii dCh 1 • I t M• I R . •